Early temporal and spatial regularization of persistent atrial fibrillation predicts termination and arrhythmia-free outcome
Background Termination of persistent atrial fibrillation (AF) is a valuable ablation endpoint but is difficult to anticipate. We evaluated whether temporal and spatial indices of AF regularization predict intraprocedural AF termination and outcome. Objective The purpose of this study was to test whe...
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| creator | Forclaz, Andrei, MD Narayan, Sanjiv M., MD, FACC, FHRS Scherr, Daniel, MD Linton, Nick, MEng, MRCP Jadidi, Amir S., MD Nault, Isabelle, MD, FRCPC Rivard, Lena, MD Miyazaki, Shinsuke, MD Uldry, Laurent, MEng Wright, Matthew, MBBS, PhD Shah, Ashok J., MD Liu, Xingpeng, MD Xhaet, Olivier, MD Derval, Nicolas, MD Knecht, Sébastien, MD Sacher, Frédéric, MD Jaïs, Pierre, MD Hocini, Mélèze, MD Haïssaguerre, Michel, MD |
| description | Background Termination of persistent atrial fibrillation (AF) is a valuable ablation endpoint but is difficult to anticipate. We evaluated whether temporal and spatial indices of AF regularization predict intraprocedural AF termination and outcome. Objective The purpose of this study was to test whether temporospatial organization of AF after pulmonary vein isolation (PVI) predicts whether subsequent stepwise ablation will terminate persistent AF or predict outcome. Methods In 75 patients with persistent AF, we measured AF cycle length (AFCL), temporal regularity index (TRI, a spectral measure of timing regularity), and spatial regularity index (SRI, cycle-to-cycle variations in spatial vector) between right atrial appendage and proximal and distal coronary sinus before and during stepwise ablation to the endpoint of AF termination. Results AF termination was achieved in 59 patients (79%) by ablation. AF terminated during PVI in 11 patients, who were excluded from analysis. In the remaining 48 patients, TRI and SRI increased during stepwise ablation, as compared with 16 patients without termination ( P |
| doi_str_mv | 10.1016/j.hrthm.2011.05.008 |
| format | Article |
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We evaluated whether temporal and spatial indices of AF regularization predict intraprocedural AF termination and outcome. Objective The purpose of this study was to test whether temporospatial organization of AF after pulmonary vein isolation (PVI) predicts whether subsequent stepwise ablation will terminate persistent AF or predict outcome. Methods In 75 patients with persistent AF, we measured AF cycle length (AFCL), temporal regularity index (TRI, a spectral measure of timing regularity), and spatial regularity index (SRI, cycle-to-cycle variations in spatial vector) between right atrial appendage and proximal and distal coronary sinus before and during stepwise ablation to the endpoint of AF termination. Results AF termination was achieved in 59 patients (79%) by ablation. AF terminated during PVI in 11 patients, who were excluded from analysis. In the remaining 48 patients, TRI and SRI increased during stepwise ablation, as compared with 16 patients without termination ( P <.05). AFCL was prolonged in both groups. From receiver operating characteristics analysis of the first 22 patients (training set), a post-PVI TRI increase predicted AF termination in the latter 42 patients (test set) with a positive predictive value of 96%, negative predictive value of 53%, sensitivity of 71%, and specificity of 91%. Results were similar for SRI. After 36 months, higher arrhythmia-free outcome was observed in patients in whom PVI caused temporospatial regularization in AF. Conclusions Temporal and spatial regularization of persistent AF after PVI identifies patients in whom stepwise ablation subsequently terminates AF and prevents recurrence.</description><identifier>ISSN: 1547-5271</identifier><identifier>EISSN: 1556-3871</identifier><identifier>DOI: 10.1016/j.hrthm.2011.05.008</identifier><identifier>PMID: 21699850</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Ablation ; Atrial fibrillation ; Atrial Fibrillation - physiopathology ; Atrial Fibrillation - surgery ; Cardiovascular ; Catheter Ablation - methods ; Electrophysiologic Techniques, Cardiac ; Female ; Heart Conduction System - physiopathology ; Humans ; Male ; Middle Aged ; Organization ; Predictive Value of Tests ; Recurrence ; ROC Curve ; Sensitivity and Specificity ; Signal processing ; Spectral analysis ; Termination ; Treatment Outcome</subject><ispartof>Heart rhythm, 2011-09, Vol.8 (9), p.1374-1382</ispartof><rights>2011</rights><rights>Published by Elsevier Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c513t-30aa35409170288aaecb1662e4a394928b8c0e6dd917ddb4d2cabab2cd7ef2e13</citedby><cites>FETCH-LOGICAL-c513t-30aa35409170288aaecb1662e4a394928b8c0e6dd917ddb4d2cabab2cd7ef2e13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.hrthm.2011.05.008$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,780,784,885,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21699850$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Forclaz, Andrei, MD</creatorcontrib><creatorcontrib>Narayan, Sanjiv M., MD, FACC, FHRS</creatorcontrib><creatorcontrib>Scherr, Daniel, MD</creatorcontrib><creatorcontrib>Linton, Nick, MEng, MRCP</creatorcontrib><creatorcontrib>Jadidi, Amir S., MD</creatorcontrib><creatorcontrib>Nault, Isabelle, MD, FRCPC</creatorcontrib><creatorcontrib>Rivard, Lena, MD</creatorcontrib><creatorcontrib>Miyazaki, Shinsuke, MD</creatorcontrib><creatorcontrib>Uldry, Laurent, MEng</creatorcontrib><creatorcontrib>Wright, Matthew, MBBS, PhD</creatorcontrib><creatorcontrib>Shah, Ashok J., MD</creatorcontrib><creatorcontrib>Liu, Xingpeng, MD</creatorcontrib><creatorcontrib>Xhaet, Olivier, MD</creatorcontrib><creatorcontrib>Derval, Nicolas, MD</creatorcontrib><creatorcontrib>Knecht, Sébastien, MD</creatorcontrib><creatorcontrib>Sacher, Frédéric, MD</creatorcontrib><creatorcontrib>Jaïs, Pierre, MD</creatorcontrib><creatorcontrib>Hocini, Mélèze, MD</creatorcontrib><creatorcontrib>Haïssaguerre, Michel, MD</creatorcontrib><title>Early temporal and spatial regularization of persistent atrial fibrillation predicts termination and arrhythmia-free outcome</title><title>Heart rhythm</title><addtitle>Heart Rhythm</addtitle><description>Background Termination of persistent atrial fibrillation (AF) is a valuable ablation endpoint but is difficult to anticipate. We evaluated whether temporal and spatial indices of AF regularization predict intraprocedural AF termination and outcome. Objective The purpose of this study was to test whether temporospatial organization of AF after pulmonary vein isolation (PVI) predicts whether subsequent stepwise ablation will terminate persistent AF or predict outcome. Methods In 75 patients with persistent AF, we measured AF cycle length (AFCL), temporal regularity index (TRI, a spectral measure of timing regularity), and spatial regularity index (SRI, cycle-to-cycle variations in spatial vector) between right atrial appendage and proximal and distal coronary sinus before and during stepwise ablation to the endpoint of AF termination. Results AF termination was achieved in 59 patients (79%) by ablation. AF terminated during PVI in 11 patients, who were excluded from analysis. In the remaining 48 patients, TRI and SRI increased during stepwise ablation, as compared with 16 patients without termination ( P <.05). AFCL was prolonged in both groups. From receiver operating characteristics analysis of the first 22 patients (training set), a post-PVI TRI increase predicted AF termination in the latter 42 patients (test set) with a positive predictive value of 96%, negative predictive value of 53%, sensitivity of 71%, and specificity of 91%. Results were similar for SRI. After 36 months, higher arrhythmia-free outcome was observed in patients in whom PVI caused temporospatial regularization in AF. Conclusions Temporal and spatial regularization of persistent AF after PVI identifies patients in whom stepwise ablation subsequently terminates AF and prevents recurrence.</description><subject>Ablation</subject><subject>Atrial fibrillation</subject><subject>Atrial Fibrillation - physiopathology</subject><subject>Atrial Fibrillation - surgery</subject><subject>Cardiovascular</subject><subject>Catheter Ablation - methods</subject><subject>Electrophysiologic Techniques, Cardiac</subject><subject>Female</subject><subject>Heart Conduction System - physiopathology</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Organization</subject><subject>Predictive Value of Tests</subject><subject>Recurrence</subject><subject>ROC Curve</subject><subject>Sensitivity and Specificity</subject><subject>Signal processing</subject><subject>Spectral analysis</subject><subject>Termination</subject><subject>Treatment Outcome</subject><issn>1547-5271</issn><issn>1556-3871</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFUstu1TAQjRCIPuALkFB2rBLGdpzHgkqoKgWpEgtgbTn2pNeXJA5jp9JFfDwOt1TAhpXH9pkzZ-ZMlr1gUDJg9et9uaO4m0oOjJUgS4D2UXbKpKwL0Tbs8RZXTSF5w06ysxD2ALyrQTzNTjiru66VcJr9uNI0HvKI0-JJj7mebR4WHV2KCW_XUZP7nq5-zv2QL0jBhYhzzHWkDTO4ntw4HhELoXUmhkRHk5uPjxujJtodklani4EQc79G4yd8lj0Z9Bjw-f15nn15d_X58n1x8_H6w-Xbm8JIJmIhQGshK-hYA7xttUbTs7rmWGnRVR1v-9YA1tYmgLV9ZbnRve65sQ0OHJk4zy6OvMvaT2hN0p96VQu5SdNBee3U3z-z26lbf6cEq0XDeSJ4dU9A_tuKIarJBYOp7xn9GlTbyg5qLmVCiiPSkA-BcHiowkBttqm9-mWb2mxTIFWyLWW9_FPgQ85vnxLgzRGAaUx3DkkF43A2ad6EJirr3X8KXPyTb0Y3O6PHr3jAsPcrzckBxVTgCtSnbXO2xWEMQMqGiZ-Z58S2</recordid><startdate>20110901</startdate><enddate>20110901</enddate><creator>Forclaz, Andrei, MD</creator><creator>Narayan, Sanjiv M., MD, FACC, FHRS</creator><creator>Scherr, Daniel, MD</creator><creator>Linton, Nick, MEng, MRCP</creator><creator>Jadidi, Amir S., MD</creator><creator>Nault, Isabelle, MD, FRCPC</creator><creator>Rivard, Lena, MD</creator><creator>Miyazaki, Shinsuke, MD</creator><creator>Uldry, Laurent, MEng</creator><creator>Wright, Matthew, MBBS, PhD</creator><creator>Shah, Ashok J., MD</creator><creator>Liu, Xingpeng, MD</creator><creator>Xhaet, Olivier, MD</creator><creator>Derval, Nicolas, MD</creator><creator>Knecht, Sébastien, MD</creator><creator>Sacher, Frédéric, MD</creator><creator>Jaïs, Pierre, MD</creator><creator>Hocini, Mélèze, MD</creator><creator>Haïssaguerre, Michel, MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20110901</creationdate><title>Early temporal and spatial regularization of persistent atrial fibrillation predicts termination and arrhythmia-free outcome</title><author>Forclaz, Andrei, MD ; Narayan, Sanjiv M., MD, FACC, FHRS ; Scherr, Daniel, MD ; Linton, Nick, MEng, MRCP ; Jadidi, Amir S., MD ; Nault, Isabelle, MD, FRCPC ; Rivard, Lena, MD ; Miyazaki, Shinsuke, MD ; Uldry, Laurent, MEng ; Wright, Matthew, MBBS, PhD ; Shah, Ashok J., MD ; Liu, Xingpeng, MD ; Xhaet, Olivier, MD ; Derval, Nicolas, MD ; Knecht, Sébastien, MD ; Sacher, Frédéric, MD ; Jaïs, Pierre, MD ; Hocini, Mélèze, MD ; Haïssaguerre, Michel, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c513t-30aa35409170288aaecb1662e4a394928b8c0e6dd917ddb4d2cabab2cd7ef2e13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Ablation</topic><topic>Atrial fibrillation</topic><topic>Atrial Fibrillation - physiopathology</topic><topic>Atrial Fibrillation - surgery</topic><topic>Cardiovascular</topic><topic>Catheter Ablation - methods</topic><topic>Electrophysiologic Techniques, Cardiac</topic><topic>Female</topic><topic>Heart Conduction System - physiopathology</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Organization</topic><topic>Predictive Value of Tests</topic><topic>Recurrence</topic><topic>ROC Curve</topic><topic>Sensitivity and Specificity</topic><topic>Signal processing</topic><topic>Spectral analysis</topic><topic>Termination</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Forclaz, Andrei, MD</creatorcontrib><creatorcontrib>Narayan, Sanjiv M., MD, FACC, FHRS</creatorcontrib><creatorcontrib>Scherr, Daniel, MD</creatorcontrib><creatorcontrib>Linton, Nick, MEng, MRCP</creatorcontrib><creatorcontrib>Jadidi, Amir S., MD</creatorcontrib><creatorcontrib>Nault, Isabelle, MD, FRCPC</creatorcontrib><creatorcontrib>Rivard, Lena, MD</creatorcontrib><creatorcontrib>Miyazaki, Shinsuke, MD</creatorcontrib><creatorcontrib>Uldry, Laurent, MEng</creatorcontrib><creatorcontrib>Wright, Matthew, MBBS, PhD</creatorcontrib><creatorcontrib>Shah, Ashok J., MD</creatorcontrib><creatorcontrib>Liu, Xingpeng, MD</creatorcontrib><creatorcontrib>Xhaet, Olivier, MD</creatorcontrib><creatorcontrib>Derval, Nicolas, MD</creatorcontrib><creatorcontrib>Knecht, Sébastien, MD</creatorcontrib><creatorcontrib>Sacher, Frédéric, MD</creatorcontrib><creatorcontrib>Jaïs, Pierre, MD</creatorcontrib><creatorcontrib>Hocini, Mélèze, MD</creatorcontrib><creatorcontrib>Haïssaguerre, Michel, MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Heart rhythm</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Forclaz, Andrei, MD</au><au>Narayan, Sanjiv M., MD, FACC, FHRS</au><au>Scherr, Daniel, MD</au><au>Linton, Nick, MEng, MRCP</au><au>Jadidi, Amir S., MD</au><au>Nault, Isabelle, MD, FRCPC</au><au>Rivard, Lena, MD</au><au>Miyazaki, Shinsuke, MD</au><au>Uldry, Laurent, MEng</au><au>Wright, Matthew, MBBS, PhD</au><au>Shah, Ashok J., MD</au><au>Liu, Xingpeng, MD</au><au>Xhaet, Olivier, MD</au><au>Derval, Nicolas, MD</au><au>Knecht, Sébastien, MD</au><au>Sacher, Frédéric, MD</au><au>Jaïs, Pierre, MD</au><au>Hocini, Mélèze, MD</au><au>Haïssaguerre, Michel, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early temporal and spatial regularization of persistent atrial fibrillation predicts termination and arrhythmia-free outcome</atitle><jtitle>Heart rhythm</jtitle><addtitle>Heart Rhythm</addtitle><date>2011-09-01</date><risdate>2011</risdate><volume>8</volume><issue>9</issue><spage>1374</spage><epage>1382</epage><pages>1374-1382</pages><issn>1547-5271</issn><eissn>1556-3871</eissn><abstract>Background Termination of persistent atrial fibrillation (AF) is a valuable ablation endpoint but is difficult to anticipate. We evaluated whether temporal and spatial indices of AF regularization predict intraprocedural AF termination and outcome. Objective The purpose of this study was to test whether temporospatial organization of AF after pulmonary vein isolation (PVI) predicts whether subsequent stepwise ablation will terminate persistent AF or predict outcome. Methods In 75 patients with persistent AF, we measured AF cycle length (AFCL), temporal regularity index (TRI, a spectral measure of timing regularity), and spatial regularity index (SRI, cycle-to-cycle variations in spatial vector) between right atrial appendage and proximal and distal coronary sinus before and during stepwise ablation to the endpoint of AF termination. Results AF termination was achieved in 59 patients (79%) by ablation. AF terminated during PVI in 11 patients, who were excluded from analysis. In the remaining 48 patients, TRI and SRI increased during stepwise ablation, as compared with 16 patients without termination ( P <.05). AFCL was prolonged in both groups. From receiver operating characteristics analysis of the first 22 patients (training set), a post-PVI TRI increase predicted AF termination in the latter 42 patients (test set) with a positive predictive value of 96%, negative predictive value of 53%, sensitivity of 71%, and specificity of 91%. Results were similar for SRI. After 36 months, higher arrhythmia-free outcome was observed in patients in whom PVI caused temporospatial regularization in AF. Conclusions Temporal and spatial regularization of persistent AF after PVI identifies patients in whom stepwise ablation subsequently terminates AF and prevents recurrence.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>21699850</pmid><doi>10.1016/j.hrthm.2011.05.008</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Ablation Atrial fibrillation Atrial Fibrillation - physiopathology Atrial Fibrillation - surgery Cardiovascular Catheter Ablation - methods Electrophysiologic Techniques, Cardiac Female Heart Conduction System - physiopathology Humans Male Middle Aged Organization Predictive Value of Tests Recurrence ROC Curve Sensitivity and Specificity Signal processing Spectral analysis Termination Treatment Outcome |
| title | Early temporal and spatial regularization of persistent atrial fibrillation predicts termination and arrhythmia-free outcome |
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